treating earthquake in nepal trauma (tent) trial 2016

Conditions: Post-traumatic Stress Disorder (PTSD)

Summary: the purpose of this study is to determine whether two types of short-term trauma-focused therapies (individual narrative exposure therapy and group-based control-focused behavioural treatment) are effective in the treatment of chronic ptsd in earthquake survivors of nepal.

background: post-traumatic stress disorder (ptsd) is a common mental health disorder after natural disasters. without treatment survivors of earthquake would continue suffering from ptsd for many years. there are not many short-term trauma-focused psychosocial therapies that have been examined after natural disasters in developing countries. this study investigates the effectiveness of a 4-session revised narrative exposure therapy (net-r), and 2-session group-based control-focused behavioural treatment (cfbt-r) delivered by non-specialists with minimum supervision. methods/design: participants would be identified and recruited through a door-to-door survey of families severely affected by the 2015 earthquake in bhaktpur municipality of nepal. ptsd checklist for dsm-5 (pcl-5) will be used to screen all adult survivors (aged 18 and above) for the possible presence of ptsd, and the caps-5 interview will be used for the diagnosis of current ptsd. investigators aim to include 240 consenting participants in a single blind randomised controlled clinical trial. all participants will be randomly allocated to one of three treatment conditions (n = 80 each): 4-session revised narrative exposure therapy (net-r), 2-session group-based control-focused behavioural treatment (cfbt-r) involving instructions to conduct self-exposure, or a 3-month waiting list. in both net-r and cfbt-r interventions, treatment sessions will last 90 minutes; net-r will be delivered within a week while cfbt-r will be done over 2 weeks. all participants will be subjected to blind assessments for ptsd symptom severity with caps-5 and fear and avoidance questionnaire at pre-treatment (t0) and 3-month post-treatment (t1). discussion: the results from the post-treatment measurement would provide strong empirical reference of the safety and effectiveness of trauma-focused short-term therapies (net-r and cfbt-r) for mass trauma survivors in developing countries like nepal. it may also provide information on who may benefit most from which type of intervention.

Eligibility criteria:
inclusion criteria: * age 18 and over * must have a diagnosis of ptsd according to dsm-5 criteria with a clinically-administered ptsd scale (caps-5); during the screening, participants will be asked to report on traumatic events that fulfil dsm-5 criterion 'a'. * the ptsd symptoms must be a result of the nepal earthquake in april 2015 exclusion criteria: * high suicidality (yes to the question "have you recently had thoughts of ending your life and made any plans to this effect?) * people with severe degree of prolonged grief (grief score of 25 or more on the grief assessment scale, adapted from prigerson et al., 1999) * severe intellectual impairment, being unable to communicate and dependent on others for daily living (i.e. suffering from severe learning disability)